Original article
Combined conventional mechanical and ultrasonic debridement for aortic valvular stenosis

https://doi.org/10.1016/0003-4975(92)91141-UGet rights and content

Abstract

Ultrasound decalcification of aortic valve stenosis was performed in 31 patients. There were 16 men and 15 women with a mean age of 71.03 ± 9.6 years (range, 51 to 89 years). Each had severe calcific aortic stenosis with an aortic valve gradient greater than 40 mm Hg, aortic valve area (AVA) less than 0.6 cm2, and no serious insufficiency. Feasibility of aortic valve debridement was determined under direct vision. Intraoperative epicardial or transesophageal color Doppler two-dimensional echocardiography was used before and after the aortic valve debridement to evaluate aortic cusp motion and aortic regurgitation. Direct transseptal aortic valve gradient was measured on all patients before and after aortic valve debridement, and the AVA was determined. Aortic valve debridement was performed as the primary procedure in 17 cases and combined with other cardiac procedures in 14 patients. Preoperative aortic valve gradient was reduced from 72.5 ± 22.5 mm Hg (range, 40 to 130 mm Hg) to 15.5 ± 11.9 mm Hg (range, 2 to 50 mm Hg), and the average AVA of 0.41 ± 0.10 cm2 (range, 0.22 to 0.63 cm2) was increased to 1.55 ± 0.58 cm2 (range, 0.65 to 3.50 cm2) after ultrasound decalcification. There were two early deaths in octogenerian, high-risk patients, and two late deaths (6.45% early and 6.45% late mortality), none of them related to AVD. Postoperative follow-up included clinical evaluation and color Doppler echocardiography every 6 months. The aortic valve gradient was measured using a continuous-wave Doppler probe, and the AVA was calculated by the simplified continuity equation: AVA=aAOA×vLVOT/vAV. The mean New York Heart Association class was 3.04 ± 0.47 before operation and improved to 2 ± 0.30 after 6 to 12 months (p = 0.0001) and remained unchanged after 24 to 36 months (p = 1.000). At 3 years, echocardiography and recatheterization have shown absence of significant restenosis or aortic insufficiency. The average intraoperative AVA after repair (1.57 ± 0.58 cm2; n = 23) compared well with the calculated AVA at 12 to 18 months (1.72 ± 0.57 cm2; n = 20) and 24 to 36 months (1.43 ± 0.45 cm2; n = 14) after operation, based on one-way analysis of variance. One reoperation was necessary for early graft failure and incidental aortic valve replacement was performed. Ultrasound aortic valve debridement with preservation of the native valve appears to be an effective procedure in selected patients. Optimal results may be enhanced by combining standard debulking debridement, low-energy ultrasound, and the use of intraoperative echocardiography and by avoiding a residual AVA of less than 1.5 cm2.

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Presented at the Thirty-eighth Annual Meeting of the Southern Thoracic Surgical Association, Orlando, FL, Nov 7–9, 1991.

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